Birth Outcomes and Pregnancy Complications in Women With a History of Anorexia Nervosa

Abstract

Anorexia nervosa, a severe psychiatric illness, mainly affects adolescent girls of young childbearing age. Its key features are a refusal to maintain even minimally normal body weight, an intense fear of gaining weight, and an altered perception of body weight or shape. Postpubertal women are amenorrheic. There is some—although not conclusive—evidence that a history of anorexia nervosa increases the risk of complications during pregnancy and delivery. This study examined complications and birth outcomes in a prospective cohort of 1000 primiparous women diagnosed in the years 1973–1996 as having anorexia nervosa who gave birth in 1983–2002. They were compared with 827,582 nonanorexic primiparas who gave birth during the same years. Women in the anorexia group were less often overweight than those in the comparison group. The only child-related difference found was a significantly lower mean birth weight for infants whose mothers had been anorexic compared with control infants (3387 g and 3431 g, respectively). The P value was .005 after adjusting for maternal age and year of birth. There was no group difference in the proportion of small-for-gestational-age infants. Women in the anorexia group less often had caesarean delivery or vacuum extraction than those in the general population. On multivariate analysis, adjusting for numerous possible confounding factors, the risk of undergoing instrumental delivery was lower in the anorexia group (odds ratio, 0.7; 95% confidence interval, 0.6–0.8). Comparable findings were recorded when only 99 women who had been cared for in hospital were analyzed. Perinatal complications were no more frequent in 58 mothers who gave birth within 3 years of the first hospital discharge with anorexia nervosa. Given proper maternity care, women with a history of anorexia nervosa may expect pregnancy and delivery outcomes similar to those for the general obstetric population. It may be that specialized maternity care is not needed unless there are signs of active anorexia or other psychopathology, or if there was no previous medical care.